Petitioning coverage for ketamine infusions

Cigna (Open Access Plus, high cdhp). I live/work in Colorado but it’s an employer sponsored plan based in California I think?

I’m hoping for advice on petitioning Cigna to cover IV Ketamine infusions for long term treatment resistant depression. I have tried basically all other treatments/medications so there is a long record of tried and failed treatments, including semi-regular very expensive inpatient hospitalizations. My psychiatrist has written a referral (with diagnosis codes) and the ketamine clinic can provide a superbill. It’s not a currently covered treatment under my plan. And I’m aware it would probably be “out of network” even if they covered it. I’m ok with that. My insurance plan does cover Spravato however after doing research it wasn’t the option with best possibility of success for me. Should I just submit the claim with the superbill and wait for them to deny it? Then appeal? Should I prepare “evidence” of IV ketamine success rate? Find medical journals articles to support my case? Have my doctors write a letter? Have my HR department do some behind the scenes magic? (I did call Cigna before starting treatment but the phone reps were not helpful.

I’ve been paying for each treatment myself but this isn’t something I can continue to do realistically. This treatment has been nothing short of lifesaving and transformational for me. I’m willing to fight for coverage, I just don’t know how to best attempt this. I’ve received infusions at a legitimate clinic staffed by anesthesiologists, this isn’t a sketchy underground operation.

submitted by /u/Iko_in_denial
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